Overall Survival of Elderly Patients Having Surgery for Colorectal Cancer Is Comparable to Younger Patients: Results from a South Asian Population.

Introduction: There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC.

Method: OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed.

Resection of the large bowel suppresses hunger and food intake and modulates gastrointestinal fermentation.

Objective: To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel.

Methods: A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min).

Colorectal cancer in the young, many questions, few answers.

At a time where the incidence of colorectal cancer, a disease predominantly of developed nations, is showing a decline in those 50 years of age and older, data from the West is showing a rising incidence of this cancer in young individuals. Central to this has been the 75% increase in rectal cancer incidence in the last four decades. Furthermore, predictive data based on mathematical modelling indicates a 124 percent rise in the incidence of rectal cancer by the year 2030 - a statistic that calls for collective global thought and action.

Novel use of Absorbable Modified Polymer (AMP®); EndoClot™ as an adjunct in the management of bleeding from the liver bed during laparoscopic cholecystectomy.

Absorbable modified polymer (AMP) is a novel local haemostatic agent derived from a natural polysaccharide. Its safety and efficacy has been evaluated in upper and lower gastrointestinal bleeding without reported side effects. We report the safe use of AMP as an adjunct in the management of serious bleeding during laparoscopic cholecystectomy.

Congenital hypertrophy of retinal pigment epithelium (CHRPE) in patients with familial adenomatous polyposis (FAP); a polyposis registry experience.

Background: Familial Adenomatous Polyposis (FAP) is an autosomal dominant condition giving rise to multiple adenomatous polyps in the colon which invariably become malignant by the fourth decade. Congenital hypertrophy of retinal pigment epithelium (CHRPE) is one of its extra intestinal manifestations early in childhood seen, present in 90% of FAP population and is easy to detect.

Findings: Patients diagnosed with FAP and at risk first degree family members were screened for CHRPE using a slit lamp and indirect ophthalmoscopy.

Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report.

Introduction: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepatic biliary system or affecting both the systems.

Total number of lymph nodes harvested is associated with better survival in stages II and III colorectal cancer.

Background: Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II CRC.

Pre-operative hypoalbuminaemia predicts poor overall survival in rectal cancer: a retrospective cohort analysis.

Background: Serum albumin is a marker of nutrition and inflammation. It has recently emerged as a predictor of outcome after surgery for rectal cancer. Our aim was to evaluate if pre-operative serum albumin would predict survival after resection for rectal cancer.

Proximal and distal rectal cancers differ in curative resectability and local recurrence.

Aim: To evaluate patients with proximal rectal cancer (PRC) (> 6 cm up to 12 cm) and distal rectal cancer (DRC) (0 to 6 cm from the anal verge).

Methods: Two hundred and eighteen patients (120 male, 98 female, median age 58 years, range 19-88 years) comprised 100 with PRC and 118 with DRC. The proportion of T1, T2 vs T3, T4 stage cancers was similar in both groups (PRC: T1+T2 = 29%; T3+T4 = 71% and DRC: T1+T2 = -31%; T3+T4 = 69%).

Synchronous liver metastasis in colorectal cancer in Sri Lanka.

Objective: To assess the incidence of synchronous colorectal liver metastasis in patients referred to a tertiary referral center in Sri Lanka and to evaluate the differences in the clinicopathological features of patients with and without synchronous metastasis.

Methods: Records of 438 patients were retrospectively analyzed. Patients were classified into metastatic group (n = 34, 8%) and non metastastatic group (n = 404, 92%).

Biliary microlithiasis, sludge, crystals, microcrystallization, and usefulness of assessment of nucleation time.

Background: The process of microcrystallization, its sequel and the assessment of nucleation time is ignored. This systematic review aimed to highlight the importance of biliary microlithiasis, sludge, and crystals, and their association with gallstones, unexplained biliary pain, idiopathic pancreatitis, and sphincter of Oddi dysfunction.

Data Sources: Three reviewers performed a literature search of the PubMed database.

Colonoscopic ultrasound is associated with a learning phenomenon despite previous rigid probe experience.

Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve.

Microbiology of gallbladder bile in uncomplicated symptomatic cholelithiasis.

Background: Few studies have assessed microflora and their antibiotic sensitivity in normal bile and lithogenic bile with different types of gallstones.

Methods: We performed a case control study of 70 bile samples (35 cholesterol and 35 pigment stones from 51 females and 19 males, aged 21-72 years with a median age of 37 years) from patients who underwent laparoscopic cholecystectomy for uncomplicated cholelithiasis, and 20 controls (14 females and 6 males, aged 33-70 years with a median age of 38 years) who underwent laparotomy and had no gallbladder stone shown by ultrasound scan. The bile samples were aerobically cultured to assess microflora and their antibiotic susceptibility.

Assessment of 'nucleation time' as a predictor of cholelithiasis.

Introduction: In the formation of gallstones, crystal nucleation is a key step, which is followed by precipitation and gradual growth of cholesterol crystals.

Materials And Methods: A case-control study was carried out among 60 patients (30 patients, 14 males and 16 females, median age of 36 years, range 33-71 years, body mass index (BMI)=25.1+/-0.

Prevalence of colorectal cancer and survival in patients from the Gampaha District, North Colombo region.

Introduction: The prevalence and survival of colorectal cancer in Sri Lankans has not been previously reported. We did a retrospective and a prospective survey, in the region of North Colombo, Sri Lanka between 1992 and 2004. The aim was to study cancer burden, sites of colorectal cancer and survival after surgery.

Biofeedback with and without surgery for fecal incontinence improves maximum squeeze pressure, saline retention capacity and quality of life.

Introduction: Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in management of patients with FI.

Methods: Fifty patients (median [range] age 30 [4-77] years; 28 men) who received BFB for median (range) of 15 weeks (4-28), either postoperatively (n=39), or as the sole treatment (n=11) were evaluated.

Duodenum-preserving local excision of a gastrointestinal stromal tumor.

Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare. Because of the complex anatomy of the duodenum, the methods of resection of these tumors are controversial and diverse.

Methods: We report a case of a duodenal GIST in the anterolateral wall of the second part of the duodenum, which was successfully managed by local excision.

Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report.

Introduction: The variations in the morphological characteristics of the extra-hepatic biliary system are interesting.

Case Presentation: During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically.

Neoadjuvant therapy for rectal cancer down-stages the tumor but reduces lymph node harvest significantly.

Purpose: The impact of neoadjuvant therapy (NAT) for rectal cancer on lymph node yield is not well known. This study evaluates the impact of NAT on tumor regression and lymph node harvest.

Methods: The subjects were 40 patients with rectal cancer; 20 receiving high-dose, long-course neoadjuvant therapy, and 20 age- and sex-matched controls who did not receive neoadjuvant therapy.

Quality of life of stoma patients: temporary ileostomy versus colostomy.

Ileostomy for proximal diversion as a preferred option over colostomy has been a recent topic of interest. Our study evaluated the quality of life (QOL) of patients with a temporary ileostomy and compared it with that of patients with a temporary colostomy. The QOL of 25 patients with an ileostomy (median age 42 years, range 22-76 years) was compared with that for 25 patients with a colostomy (median age 44 years, range 18-70 years).